The high rate of recurrence and metastasis after hepatocellular carcinoma surgery is a major cause of death in liver cancer patients. Patients with liver cancer must need regular checkups, whether after radical surgery, interventional or chemotherapy.
Key components of review for liver cancer patients
Usually, patients with liver cancer should be reviewed once every 2-3 months for 1-2 years after surgery, once every 3-6 months for 3 years, once every 6 months for more than 3 years, and regularly for at least 5 years.
Reviews include alpha fetoprotein (AFP), coagulation, ultrasound, liver function, routine blood count, and HBV-DNA. If abnormalities are present, an enhanced CT or MRI should be performed promptly.
Methemoglobin
60% to 70% of patients with liver cancer will have elevated blood AFP (normal value 0-20ng/ml), and AFP is an important marker for diagnosing liver cancer.
Usually after surgical removal of a liver tumor, the blood AFP gradually decreases to normal levels. Once recurrence occurs after surgery, some patients’ blood AFP rises again.
Therefore, regular testing of blood AFP can help in the early diagnosis of postoperative recurrence of liver cancer. If AFP is elevated, it may indicate a postoperative recurrence of liver cancer.
Ultrasound
Multicolor ultrasound is often used for regular postoperative review of patients with liver cancer and can detect tumor lesions up to about 2 cm in diameter. Compared with other imaging tests, color ultrasound is easy to perform, noninvasive, and inexpensive.
Patients with liver cancer after surgery should have regular ultrasound exams to detect recurrence of liver cancer. If ultrasound suggests recurrence of liver cancer, enhanced MRI, CT, etc. should be performed as soon as possible to determine whether recurrence or metastasis has occurred.
Liver function tests
Liver function tests help to understand the postoperative liver function of liver cancer patients, which is important for guiding postoperative treatment and predicting prognosis.
Serum bilirubin and albumin are the main indicators of liver function Child-Pugh grading, which can effectively assess patients’ postoperative liver function status.
Hepatitis virology
Most patients with hepatocellular carcinoma are clinically associated with hepatitis B or C virus infection, and some patients will be treated with oral antiviral drugs, requiring regular hepatitis virology testing to observe viral activity to indirectly prevent cancer recurrence.
HBV-DNA is direct evidence of hepatitis B virus (HBV) infection. Elevated postoperative HBV-DNA in patients with liver cancer is a high risk factor for recurrence of liver cancer.
Therefore, HBV-DNA needs to be tested regularly (every 6 months) after surgery, and if elevated HBV-DNA is found, further testing for resistance to anti-hepatitis B virus drugs is needed.
Coagulation
Coagulation testing helps to understand the synthetic function of the liver after hepatocellular carcinoma surgery.
Prolonged prothrombin time and decreased fibrinogen are mostly signs of severe postoperative liver function impairment in patients with hepatocellular carcinoma and should be reviewed as early as possible to keep abreast of changes in the condition.
Blood count
Patients with hepatocellular carcinoma should have regular blood tests to understand the development of their disease by observing changes in the number and morphological distribution of platelets, white blood cells, and red blood cells.
Misconceptions to avoid in reviewing liver cancer patients
Many patients have misconceptions about regular follow-up.
Misconception 1: Only follow up tumor markers, no need for imaging
This view is wrong. About 30% of patients with liver cancer can have normal AFP levels. In addition, tumors are heterogeneous, and some patients have significantly elevated AFP before surgery, which drops to normal after surgery, but may have normal AFP at the next recurrence.
Therefore, it is important to combine tumor markers with imaging during regular follow-up exams, otherwise the disease may be delayed.
Myth 2: Follow-up is not needed after more than 3 or 5 years
This view is also wrong. If you don’t follow up regularly after 3 or 5 years (when the tumor has not recurred), or only once a year, you may also be delayed.
Patients should be followed regularly, no more than 3 months apart.
Recurrence of liver cancer is not scary
If detected in time, with a relatively small recurrent focus, it can still be treated with re-surgical resection or radiofrequency ablation and achieve long-term survival.
Studies have found that if recurrence is followed by radical treatment such as surgical resection or local ablation, the 5-year survival rate from the time of recurrence can still be 30% to 50%.
However, a prerequisite for good relapse treatment is early detection of postoperative recurrence, so regular postoperative follow-up is important.